Q: How should we handle denied claims when the payer refuses payment under the billed status? Do we need to document that the status was changed only because the payer did not agree to any other options?
CMS is moving forward with multiple policies—effectively based on reducing reimbursement to hospitals—that have been deemed unlawful in court, according to the 2020 OPPS final rule, released Friday, November 1. However, the agency pushed its controversial price transparency proposals to a separate, yet-to-be released final rule.
The U.S. healthcare system wastes some $760 billion to $935 billion dollars each year, says a recent study published in the Journal of the American Medical Association, and between $27.2 billion and $78.2 billion of that total is the result of failures in care coordination.
In addition to physical and technical safeguards, the HIPAA Security Rule requires covered entities and business associates to implement administrative protections, including workforce training and management.
Four years after they were proposed, CMS has finalized a series of discharge planning changes that went into effect on October 29. The final rule, called Revisions to Discharge Planning Requirements [CMS-3317-F], imposes a number of new requirements—ranging from how to notify patients about their choice in postacute providers to prioritizing patient preferences when developing discharge plans and treatment goals.
The fiscal year (FY) 2020 ICD-10-CM Official Guidelines for Coding and Reporting, released shortly after the FY 2020 ICD-10-CM code release, provide instructions for healthcare professionals on how to appropriately report complex diagnoses. Coders should take time to review these changes that were implemented October 1.
